In their paper ‘To resist is to exist’ (Therapy Today, March 2009), Kemp and Pinto cite a case of a child becoming blind due to the psychological trauma attributed to reported demolition of her house. I note that her mother reportedly became ‘mute’. As an optometrist I am not in a position to comment on the psychoanalytical diagnoses regarding causes but I would ask that I be allowed to make some observations.

It is important to understand that determining the aetiology of psychosomatic visual anomalies is often complex and difficult. The literature describing visual anomalies of this nature (also termed Visual Conversion Reaction) in children would suggest that interpersonal relationship anomalies are the usual cause.¹ Visual conversion reaction is four times more common in females with modal peaks of incidence in the 13 to 14 year-old age groups.^{2, 3, 4} There may be a pubertal association. When the visual anomaly is marked, for example severe loss of vision, the literature cites sexual or mental abuse carried out by the parent or neighbour.^5,6,7

Without careful, impartial analysis carried out by an expert psychotherapist, it would be very easy to misdiagnose the aetiology or, if there was a political motive, to attribute the blame to a convenient ‘scapegoat’. I would suggest that even more care should be taken with patients who are from communities where confronting sexual abuse within families is even more taboo than usual.

In conclusion I would suggest that your readers treat with great caution the inclusion by Kemp and Pinto of this report. Further, it should be understood that if a misdiagnosis has been made in this instance or other cases, for whatever reason, any child may well be at ongoing risk from something more sinister than the cause attributed.

Simon Barnard PhD FCOptom, FAAO DipCL, DipClinOptom
Director of Ocular Medicine, Institute of Optometry, London

1. Barnard S. Psychosomatic visual anomalies. In Barnard S, Edgar D (eds) Pediatric eyecare. Blackwell Science; 1996.
2. Yasuna ER. Hysterical amblyopia in children. Am. J. Dis. Child. 1963; 106:68-73.
3. Mantyjarvi MI. The amblyopic schoolgirl syndrome. J. Paed. Ophthalmol. Strabismus. 1981; 18:30-33.
4. Rada RR, Meyer GG, Krill AE. Visual conversion reaction in children. I. Diagnosis. Psychosomatics. 1969; 10:23-28.
5. Wolpe ZS. Psychogenic visual disturbance in a four year old child. Nervous Dis. Child. 1953; 10:314.
6. Schlaegel TF. Psychosomatic ophthalmology. Baltimore: Williams & Wilkins; 1957: 370.
7. Barnard NAS. Visual conversion reaction in children. Ophthalmol. Physiol. Opt. 1989: 371-378.